Sexual Function
The genital organs receive sympathetic T11-L2 , parasympathetic S2-S4 , somatic motor Onuf's nucleus , and somatosensory innervation S2-S4 and are under supraspinal control, mostly through hypothalamic projections to the spinal cord. Hormonal factors also play an important role p. 142 . Neurological disease often causes sexual dysfunction erectile dysfunction, ejaculatory dysfunction in combination with bladder dysfunction. Isolated sexual dysfunction is more often due to psychological factors...
Memory Disorders Amnesia
Forgetfulness. Verbal memory does not decline until approximately age 60, and even then only gradually, if at all. Aging is, however, often accompanied by an evident decline in information processing ability and attention span benign senescent forgetfulness . These changes occur normally, yet to a degree that varies highly among individuals, and they are often barely measurable. They are far less severe than fullblown dementia, but they may be difficult to distinguish from incipient dementia....
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Throughout the industrialized world, the population is becoming older. It is predicted that the percentage of persons over age 65 will rise further, while that of persons under age 15 will fall. Aging is a biological process with a characteristic temporal course. Senescence refers to the physical changes associated with aging. It is still unclear whether human aging is specifically genetically predetermined or, alternatively, reflects cumulative damage incurred over time. The cellular...
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Anaplastic Astrocytoma WHO grade III and Glioblastoma WHO grade IV These infiltrative, rapidly growing tumors usually arise in adults between the ages of 40 and 65. They usually involve the cerebral hemispheres, but are sometimes found in infraten-torial locations brain stem, cerebellum, spinal cord . They are occasionally multicentric or diffuse gliomatosis cerebri is extremely rare . Infil-trative growth across the corpus callosum to the opposite side of the head is not uncommon butterfly...
Cs
1 Other forms p. 68 include Unverricht-Lundborg syndrome, myoclonus epilepsy with ragged red fibers MERFF, p. 402 , late forms of other lysosome defects e. g., sialidosis type I, GM2-gangliosidosis . 2 Cytoplasmic inclusion bodies containing glycoprotein mucopolysaccharides in the brain, muscles, skin, and liver also called Lafora disease . 3 Autosomal recessive trait, mutation at 13q14.3 0 serum ceruloplasmin,ft hepatic copper, free serum copper, and urinary copper levels, 0 rate of...
Intracranial Spaceoccupying Lesions
Extra-axial or intra-axial compression of brain tissue elevates the ICP, calling compensatory mechanisms into play once these have been exhausted, mass displacement of brain tissue occurs, possibly resulting in herniation. The distribution of pressure within the cranial cavity is a function of the structure of the brain and the partitioning of the cavity by dural folds p. 6 . Different herniation syndromes occur depending on the site and extent of the causative lesion subfalcine herniation...
Physiological Nystagmus
Physiological nystagmus serves to stabilize the visual image while the head and body are moving or when the individual looks at a moving object. The different types include congenital nystagmus often X-linked recessive fixation nystagmus is most pronounced when gazing fixedly on an object the direction of nystagmus is usually horizontal , spasmus nutans pendular nystagmus beginning in the first year of life often accompanied by nodding of the head and torticollis disappears spontaneously ,...
E
Different areas of the cerebral cortex neocortex may be distinguished from one another by their histological features and neuroanatomical connections. Brodmann's numbering scheme for cortical areas has been used for many years and will be introduced in this section. Projection areas. By following the course of axons entering and leaving a given cortical area, one may determine the other structures to which it is connected by afferent and efferent pathways. The primary projection areas are those...
Pds
changes during epileptic seizure recording data from animal experiments The differentiation of epileptic from nonepileptic seizures is of major prognostic and therapeutic importance. Nonepileptic seizures may or may not involve loss of consciousness. Pseudo-seizures resemble epileptic seizures p. 192 ff , but are of nonepileptic origin. This broad category includes syncope, psychogenic seizures, and simulated seizures. Pseudoseizure, in the narrower sense, is a synonym for psychogenic seizure....
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The first symptoms of HD typically appear between the ages of 35 and 45 years. HD appearing before age 20 the Westphal variant of HD is characterized by akinesia, bradykinesia, epileptic seizures, action tremor, and myoclonus. Onset before age 10 or after age 70 is rare. HD patients require total nursing care 10-15 years after the onset of this inexorably progressive, and ultimately fatal degenerative disease. Early stage. In cases of earlier onset, akinesia and cognitive impairment tend to be...
Deglutition
Mechanism. The food is ground by the teeth and moistened with saliva to form chyme, which is molded by the tongue into an easily swallowed bolus oral preparatory phase . The tongue pushes the bolus into the oropharynx oral phase to initiate the reflex act of swallowing pharyngeal phase . The lips and jaw close, the soft palate rises to seal off the nasopharynx, and the bolus bends the epiglottis backward. The bolus is pushed further back by the tongue, respiration briefly ceases, and the raised...
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Early myoclonic encephalopathy unspecific etiology seizures secondary to various diseases Neonatal convulsions acquired epileptic aphasia Landau-Kleffner syndrome Febrile convulsions isolated seizure or isolated status epilepti-cus acute metabolic or toxic triggers right temporoparietal -wave activity Prenatal lesions disturbances Metabolic diseases Congenital anomalies Encephalitis Genetic disorders Head trauma Brain tumor Cerebrovascular disorders VVWVWVVVVVWUVV Arv M VVVVVVAA generalized 3...
Dysarthria Dysphonia
Dysarthria impaired articulation and dys-phonia impaired phonation and resonance result from a disturbance of the neural control mechanism for speech sensory portion, motor portion, or both . Diagnostic assessment requires both analysis of the patient's vocal output breathing, phonation, resonance, articulation speed, coordination, and prosody of speech and the determination of any associated neurological findings e.g. dysphagia, hyperkinesia, cranial nerve deficits . For responsible lesions...
O Nlz
Pathogenesis. There are three types of poliovirus type 1 ca. 85 of all infections , type 2 and type 3. Like other enteroviruses e.g., coxsackievirus, echovirus, and hepatitis-A virus , they are transmitted via the fecal-oral and oraloral routes, and poor sanitary conditions favor their spread. Having entered the body, the virions infiltrate epithelial cells, where they replicate, and then spread to the lymphatic tissues of the nasopharynx tonsils and intestinal wall Peyer's patches . A second...
Speech
The neural basis of speech. Speech-related movement programs generated in the premotor cortex area 6 are modulated by information from the cerebellum and basal ganglia and are relayed to the motor cortex inferior portion of the precentral gyrus, area 4 for implementation. The motor cortex projects by way of the corticopontine and corticobulbar tracts to the motor cranial nerve nuclei in the brain stem. CN V mandibular nerve controls the muscles that open and close the jaw masseter, temporalis,...
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Astrocytoma WHO grades I and II Astrocytomas arise from blastomatous astrocytes. They are classified as benign WHO grade I or semibenign WHO grade II according to their histological features p. 377 . Pilocytic astrocytoma WHO grade I is a slowly growing tumor that mainly occurs in children and young adults and usually arises in the cerebellum, optic nerve, optic chiasm, hypothalamus, or pons. It is not uncommonly found in the setting of neurofibromatosis I. There may be a relatively long...
C 1
Disturbances of the peripheral nervous system may be subdivided into those affecting neuronal cell bodies neuronopathy and those affecting peripheral nerve processes peripheral neuropathy . Neuronopathies include anterior horn cell syndromes motor neuron lesions p. 50 and sensory neuron syndromes sensory neuronopathy, ganglionopathy pp.2, 107, 390 . Motor neuron diseases are described on p. 304. Peripheral neuropathy is characterized by damage to myelin sheaths myelinopathy and or axons...
Pathogenesis
Pain results from the interaction of a noxious i.e., pain-producing stimulus with a receptor, and the subsequent transmission and processing of pain-related signals in the PNS and CNS the entire process is called nociception. Pain evokes a behavioral response involving nocifensor activity as well as motor and auto-nomic reflexes. Pain reception. Nociceptors for mechanical, thermal, and chemical stimuli are found in all body organs except the brain and spinal cord. By releasing neuropeptides,...
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Hypoxic-ischemic encephalopathy. An acute lack of oxygen Pao2 lt 40mmHg , severe hypotension lt 70mmHg systolic , or a combination of the two causes loss of consciousness within minutes. The most important causes of hypoxic and ischemic states are an inadequate pumping function of the heart as in myocardial infarction, shock, and cardiac arrhythmia , suffocation, carbon monoxide poisoning, respiratory muscle paralysis as in spinal trauma, Guil-lain-Barr syndrome, and myasthenia , and inadequate...
E Kop
Progressive paraparesis or quadriparesis, spasticity, Lher-mitte's sign, reduced mobility of cervical spine cervical radiculopathy may also occur Spinal cord compres-sion2 by cervical spine lesions3 MRI, CT, myelography evoked potentials, EMG for radicular lesions, plain radiograph of cervical spine. Treatment Surgery for progressive impairment or severe stenosis otherwise, symptomatic treatment Lumbar spinal stenosis4 intermittent claudication Early Paresthesiae sensation of heaviness occur...
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1 Chromosome location CL . 2 Classic form. 3 Bassen-Kornzweig syndrome vitamin A and E deficiency, low cholesterol triglyceride levels, acanthocytosis. 4 Louis-Bar syndrome. 5 Oculomotor apraxia. 6 DNA repair kinase cell cycle control ataxia-telangiectasia-mutated ATM gene. 7 A direct gene test is available. For mitochondrial syndromes with ataxia, see p. 403. I Autosomal Dominant Cerebellar Syndromes partial listing Autosomal dominant cerebellar ataxia ADCA spinocerebellar ataxia SCA 1...
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Foot deformity, cerebral palsy, Duchenne muscular dystrophy, habit Paraspastic gait, leg circumduction, spastic-ataxic gait, Wernicke-Mann gait Pyramidal tract, extrapyramidal motor system su-pratentorial, infratentorial, spinal Unilateral or bilateral central paralysis with spasticity, stiff-man syndrome Gait ataxia, staggering gait, unsteady gait, tabetic gait, reeling gait Peripheral nerves, posterior column of spinal cord, spinocerebellar tracts, cerebellum, thalamus, postcentral cortex...
C Sgc
Patients usually complain mainly of positive sensory symptoms tingling, burning, intense pain , which, like the accompanying sensory deficit mainly hypalgesia, see p. 104 f , are in a dermatomal distribution p. 32 ff . Weakness, if any, is found mainly in muscles that are largely or entirely innervated by a single nerve root pp. 32, 50 loss of the segmental deep tendon reflex p. 40 is, however, a typical early finding. Monoradiculopathy does not cause any evident autonomic dysfunction in the...
Info Ieb
Euphoria somnolence o coma, respiratory depression Euphoria, panic, depression, hallucinations, illusions Ataxia, tremor, increased muscle tone Euphoria, dysphoria, psychosis, aggressiveness, hallucinations coma rare 1 Epileptic seizures may occur. 2 Cerebral infarction or hemorrhage may occur. 3 0 weak brisk or increased. 4 Methylenedioxymethamphetamine ecstasy. 5 Causes dehydration, hyponatremia, cerebral edema, cardiovascular complications, hyperthermia, rhabdomyolysis. 6 Myelopathy,...
Cerebral Blood Flow
Cerebral blood flow CBF is a function of the cerebral perfusion pressure CPP , which normally ranges from 70 to 100 mmHg, and the cerebral vascular resistance CVR CBF CPP CVR. CBF is maintained at a constant value of approximately 50 ml 100 g min as long as the mean arterial pressure MAP 1 remains in the relatively wide range from 50 to 150 mmHg cerebral autoregulation . When the patient is lying flat, CPP MAP - ICP. A rapid rise in the systemic arterial pressure is followed by a slow, delayed...
O Dkh
Posttraumatic headache may be acute lt 8 weeks after head trauma or chronic gt 8 weeks . The duration and intensity of the headache are not correlated with the severity of the precipitating head trauma. It can be focal or diffuse, continuous or episodic. It often worsens with physical exertion, mental stress, and tension and improves with rest and stress avoidance. Its type and extent are highly variable. If the headache gradually increases in severity, or if a new neurological deficit arises,...
Stroke Syndromes Vertebrobasilar Territory
High-grade subclavian stenosis or occlusion proximal to the origin of the vertebral artery may cause a reversal of blood flow in the vertebral artery, which worsens with exertion of the ipsilateral arm subclavian steal . Rapid arm fatigue and pain often result less common are vertigo and other brain stem signs. The arterial blood pressure is measurably different in the two arms. VA occlusion produces variable combinations of symptoms and signs, including homonymous hemianopsia, dysarthria,...
Nodules On Iris In Multiple Sclerosis
The phakomatoses neurocutaneous diseases are a group of congenital diseases in which pathological changes are found in both the central nervous system and the skin. Neurofibromatosis, tuberous sclerosis, and von Hippel-Lindau disease are transmitted in an autosomal dominant inheritance pattern with high penetrance and variable phenotypic expression. These disorders are generally characterized by the formation of benign nodules hamartoma malignant tumors e.g., hamartoblastomas are rare....
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Encephalopathy due to sepsis, multiple organ failure, or burns may arise within a few hours, manifesting itself as impaired concentration, disorientation, confusion, and psychomotor agitation in addition to the already severe systemic disturbances. In severe cases, there may be delirium, stupor or coma. Focal neurological signs are absent meningismus may be present, and CSF studies do not show signs of meningoencephalitis. There are nonspecific EEG changes generalized delta and theta wave...
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Dementia. Impairment of memory and concentration in early PD-associated dementia may be difficult to distinguish from depressive manifestations. The side effects of pharmacotherapy p. 212 must be kept in mind before treatment is initiated for patients suffering from disorientation, confusion, suspiciousness, and other emotional changes. Impaired memory is usually not a major feature of PD as the disease progresses, about 20 of patients develop decreased flexibility of thought and action,...
Mri
Tumor, myelitis, vascular myelopathy, MR myelography Vertebral body lesions trauma, neoplasm, inflammation, degeneration Inflammatory, hemorrhagic vascular , or neoplastic changes Position-dependent changes dynamic spondylolisthesis , spinal stenosis, arachnoiditis, nerve root avulsion Arteriovenous fistula malformation, location of source of hemorrhage 1 Urodynamic tests are used to evaluate bladder dysfunction p. 156 . 2 Somatosensory EP. 3 Motor EP. 4 Central motor conduction time CMT . 5...
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usual, common, occasional, - rare, - absent usual, common, occasional, - rare, - absent n-Henoch vasculitis and essential cryoglobulin n-Henoch vasculitis and essential cryoglobulin Microscopic polyangiitis Wegener granulomatosis, Churg-Strauss syndrome Polyarteritis nodosa, Kawasaki disease Temporal arteritis, Takayasu arteritis gray regions most commonly affected by systemic vasculitis Tension headache often involves painful cervical muscle spasm, may change with the weather, and is...
Q
Taste buds. Each taste bud contains 50-150 gustatory cells. Taste buds are found on the margins and furrows of the different types of gustatory papillae fungiform, foliate, and vallate and are specific for one of the four primary tastes, sweet, sour, salty, and bitter. The lifespan of each gustatory cell is approximately one week. Filaments called microvilli projecting from the cells' upper poles are coated with gustatory receptor molecules. Stimulation of the gustatory cell at its receptors by...
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Progressive Multifocal Leukoencephalopathy PML Pathogenesis. The causative organism, JC virus, is a ubiquitous papovavirus that usually stays dormant within the body. It is reactivated in persons with impaired cellular immunity and spreads through the bloodstream to the CNS, where it induces multiple white-matter lesions. Symptoms and signs. PML appears as a complication of cancer chronic lymphatic leukemia, Hodgkin lymphoma , tuberculosis, sarcoidosis, immune suppression, and AIDS, producing...
Intracranial Hypertension
The normal intracranial pressure ICP is 60-120 mmH2O, which corresponds to 5-15 mmHg. An ICP greater than 30 mmHg impairs cerebral blood flow an ICP greater than 50 mmHg for more than 30 minutes is fatal an ICP greater than 80 mmHg for any length of time can cause brain damage. Intracranial hypertension may be either acute developing in hours to days or chronic lasting for weeks or months . Its manifestations are progressively more severe as the ICP rises, but are not specific thus, the...
Pathological Nystagmus
Gaze-evoked nystagmus occurs only in certain direction s of gaze. The main causes are drug intoxication and brain stem or cerebellar disturbances. A slower and coarser gaze-paretic nystagmus may be seen in association with su-pranuclear or peripheral gaze palsy, beating in the direction of the paretic gaze. Peripheral palsy of an eye muscle may cause unilateral nystagmus of the affected eye. Spontaneous nystagmus is that which occurs when the eyes are in the primary position it is usually...
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Treatment. Physical, occupational, and speech therapy and perception training should be started as soon as possible. Botulinum toxin can be useful in the treatment of spasticity at certain sites dynamic talipes equinus, leg adductors, arm flexors . Other measures Orthopedic care, seeing and hearing aids, developmental support. Hydrocephalus is dilatation of the cerebral ventricles p. 8 due to obstruction of CSF outflow p. 162 . Common etiologies include aqueductal stenosis, Dandy-Walker and...
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green, compensation red, decompensation Etiology of hydrocephalus right normal state Subfalcine herniation Ventricular compression Edema of astrocytes endothelial cells Etiology of hydrocephalus right normal state Subfalcine herniation Ventricular compression Edema of astrocytes endothelial cells Pontomesencephalic compression, hemorrhages Open zonula occludens tight junction Pontomesencephalic compression, hemorrhages Cerebral edema left, vasogenic right, cytotoxic
Q Ujm
Herniation syndromes p. 162 . Transtentorial herniation causes an ipsilateral oculomotor nerve palsy ptosis, mydriasis, and secondary ophthalmoplegia , contralateral hemiplegia, and decere-bration syndrome p. 46 . Downward herniation of the contents of the posterior fossa into the foramen magnum causes neck pain and stiffness, a head tilt, and shoulder paresthesiae. If medullary compression is also present, respiratory and circulatory disorders, cerebellar fits, and obstructive hydrocephalus...
Stroke Syndromes Carotid Artery Territory
Brachiocephalic trunk occlusion by emboli from the aortic arch has the same clinical manifestations as internal carotid artery ICA occlusion. Patients with adequate collateral flow remain asymptomatic. Common Carotid Artery CCA CCA occlusion is very rare and, even when it occurs, is usually asymptomatic, because of an adequate collateral supply. When symptoms do occur, they are the same as those of ICAocclusion. Internal Carotid Artery ICA Territorial infarcts affect the middle cerebral artery...
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These diseases involve a degeneration of the cerebral and or spinal motor neurons p. 44 . They present with a wide variety of neurological syndromes of varying temporal course. Upper Motor Neuron Diseases p. 46 Table 45, p. 384 Hereditary. Familial spastic spinal paralysis p. 286 , adrenomyeloneuropathy, spinocerebellar ataxia type 3 p. 280 . Acquired. Lathyrism central spastic paraparesis due to a neurotoxin in the pulse Lathyrus sativus grass pea , a dietary staple in certain poor districts...
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Time course of ischemic lesion development CBV Cerebral blood volume GU Cerebral glucose utilization O2 Cerebral oxygen extraction O7U Cerebral oxygen utilization VGCC Voltage-gated calcium channels VGCC Voltage-gated calcium channels Collateral vessel vascular reserve Collateral vessel vascular reserve
O
The vertebral artery arises from the arch of the subclavian artery at a point designated V0. The prevertebral or V1 segment extends from V0 to the foramen transversarium of the transverse process of C6. The transversarial or V2 segment passes vertically through the foramina transversaria of C6 through C2, accompanied by venous plexuses and sympathetic nerves derived from the cervical ganglia. It gives off branches to the cervical nerves, vertebrae and intervertebral joints, neck muscles, and...
Se 1
Language is a means of transmitting and processing information, organizing sensory perceptions, and expressing thoughts, feelings, and intentions. The content of language encompasses the past, present, and future. The development of language does not necessarily require speech and audition deaf-mutes learn to communicate with sign language. Language is most easily acquired in childhood. Linguistic messages are transmitted and received through speaking and hearing, writing and reading, or in the...
Ws
bladder, bowel, circulatory system genital organs, sweating left, dermatomes right, segment-indicating muscles Paralysis of peripheral origin can be caused by lesions of the anterior horn lower motor neuron, LMN , nerve root, peripheral nerve, or motor end plate and must be distinguished from weakness due to disease of the muscle itself myopathy . Apparent weakness can also be produced by tendon rupture or injury to bones and joints. Paralysis. Paralysis is accompanied by diminution of muscle...
Peripheral Oculomotor Disturbances
Weakness of an extraocular muscle results in diplopia, which is most pronounced in the direction of action of the affected muscle p. 85 . The cause may be a lesion in the muscle itself, in the cranial nerve that supplies it, or in the cranial nerve nucleus. Examination. The more peripheral of the two images seen by the patient is always derived from the affected eye. The impaired eye movement may be seen directly by observation of conjugate eye movements in the nine cardinal directions of gaze...
Sinus Thrombosis
Symptoms and signs. Aseptic sinus thrombosis most commonly affects the superior sagittal sinus and produces initial headache, vomiting, and focal epileptic seizures, followed by monoparesis or hemiparesis, papilledema, abulia, and impairment ofconsciousness. Blockage ofvenous outflow causes cerebral edema and rupture of the distended cerebral veins upstream from the thrombosis.Septicsinus thrombosis is heralded by fever, chills, and malaise. Pain, redness, and swelling of the eye or ear may...
S Dix
1 Meningocele Only the meninges protrude through the skull defect. Meningoencephalocele Meninges brain. Meningoen-cephalocystocele meninges brain ventricular system. 2 In maternal serum also in amniotic fluid in open defects. 3 Type I unilateral or bilateral cerebellar tonsillar herniation with or without caudal displacement of medulla hydrocephalus, syringomyelia p. 284 there may be an accompanying anomaly of the skull base. Type II same as type I caudal displacement of medulla, parts of...
Spinal Cord Lesion
Sensory loss in perianal region and inner thigh Flaccid paralysis of bladder and bowel, loss of erectile function 1 Spinal cord level not the same as vertebral level . 2 See p. 32ff. 3 Disturbance of bladder, bowel, rectal, and erectile function, sweating, and blood pressure regulation p. 140ff. 4 High cervical cord lesion. 5 Low cervical cord lesion. 6 Epiconus. 7 Conus medullaris. Chronic stage late sequelae. Persistence of neurological deficits assorted complications including venous...
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The clinical differential diagnosis of myelopathies is based on the level of the spinal cord lesion, the particular structures affected, and the temporal course of the disorder p. 48, Table 39, p. 381 . Symptoms and signs develop within minutes, hours, or days. Viral myelitis p. 234 ff . Enteroviruses poliovirus, coxsackievirus, echovirus , herpes zoster virus, varicella zoster virus, FSME, rabies, HTLV-1, HIV, Epstein-Barr virus, cytome-galovirus, herpes simplex virus, postvaccinial myelitis....